Foucault begins his description of madness with the evolution of madness as a definition. He contends that leprosy was Europe’s first description of madness, as the population considered those afflicted with the disease to be “mad.” These patients were cast out by society and forced to live in isolation due not only to the contagious nature of the disease, but also to the negative social stigma behind it. These people were only patients afflicted with a disease and thus in need of medical attention; they were instead considered “different” from the rest of society and, thus, shunned. Although the disease of leprosy disappeared, the negative concept of madness remained, along with society’s need to confine those afflicted with the perceived condition. As leprosy disappeared from society a new device, the idea of the “Ship of Fools,” or “Narrenschiff,” appeared. Sebastian Brand’s fifteenth century book of the same name describes the method by which towns would expel these “madmen:” by expelling them away from society on one of many ships designated specifically for the “mad.” Foucault explain that towns dealt with madmen—now characterized not by leprosy but by their abnormal behavior—by expelling them.

It was society’s transition from leprosy to abnormal behavior as its preferred definition of madness that sparked a visual and literary movement that presented madness as a central theme in many people’s lives. Foucault contends that, in the literature and artwork of the Middle Ages, madness was almost always correlated heavily with death and the apocalypse—both central themes in this period of time. He notes that with the advent of the Renaissance came a freestanding representation of madness reflected by literature, and, as a result, an increased acceptance of madness in society. For a brief time in European history madness was not considered a condition to be confined, but instead, a condition to be studied. The image of a madman fascinated people due to the fact that literary characterized them as people who possessed a wisdom that the average man does not have: a knowledge of the end of the world, or the destruction of humanity. This literary representation of madness is demonstrated by Shakespeare and Cervantes in their respective works King Leer and Don Quixote, as they both present madness as one of the worst afflictions that can befall anyone because it ultimately destroys their humanity.

Where the Renaissance accepted the idea of madness the Classical Age aimed to confine it. The seventeenth century created many enormous hoses of confinement in order to put away those considered “mad.” Foucault describes the opening of Paris’s Hopital General in 1656 as a key date for the beginning of the trend of confinement for the mad. Its name may be deceiving—the establishment was not a medical facility but rather an area of confinement for those deemed unfit to live in society. At its high point the Hopital housed one percent of the population of Paris. This trend of confinement extended throughout France and the rest of Europe and, along with it, came a new social stigma behind madness. The public were no longer interested in the mad but rather disgusted. The rise of the Reformation led many to regard those with a lax work ethic as a lesser being and, therefore, mad. Because of this, these new houses confinement not only held the insane, but also those deemed lazy by society, beggars, and the unemployed. They were watched over by police and forced to work long hours of hard labor to instill in them a new work ethic while contributing to the prosperity of all. These houses were maintained also with the intention of instilling a new moral and religious order in their prisoners, as many were often visited by priests and missionaries. Foucault uses these houses of confinement to draw a contrast between the openly acknowledged madness seen in King Lear and Don Quioxte and, only a half a century later, the public’s new idea that the mad need to be confined.

Although many of those classified as “mad” were simply beggars or those befallen under unusual circumstances, some characteristics of perceived mental disorders were diagnosed and studied by doctors. Foucault explains that the two major types of madness were developed in the sixteenth century and dubbed as melancholia, mania, hypochondria, and hysteria. Although the symptoms varied on location, the most common for the former consisted of not only depression, but also unreal or false beliefs. Mania served as its contrast as those with the affliction were characterized as highly excitable, wild, and uncontrollable. Hysteria, typically found in women, consisted of the archaic idea of spirits entering the body and causing spasms and convulsions. Hypochondria had similar symptoms to its modern day definition: patients often falsely believed themselves to be ill. Foucault explains that, up until the eighteenth century, doctors believed that these illnesses were caused by the abnormal movement of animal spirits, apparitions that were considered to be inside us all. From the seventeen hundreds onward, this view was replaced by the more realistic image of tension in nerve fibers.

Foucault repeatedly attempts to prove his thesis through his own ideals but does not provide satisfactory evidence to back up his claims. This is evident from early on in the book, as his analysis of containment relating to the “Ship of Fools” that supposedly occurred during the end of the Middle Ages is only backed up via the singular book by Sebastian Brand. When he describes the various symptoms of madness Foucault cites only one eighteenth century physician by the name of Willis, and when he describes the Hopital General and the epidemic of containment that followed, Foucault only provides evidence from a single Hopital in France. Although he does provide evidence to back up his claims, Foucault falls short on the amount of satisfactory evidence. He provides no credentials for the doctors that he cites and the information that he garnered, leaving the reader unable to determine the credibility of the few pieces of evidence provided.

Because he is a philosopher first and a historian second, Foucault’s dabble into historical analysis gave way into his own personal views and, thus, turned an intended work of history into a philosophical analysis. In many chapters, most specifically the chapter entitled “Passion and Delirium,” in which the author describes the correlation of crimes of passion with mental illness, Foucault cites no pieces of evidence nor any historically documented events, leaving the interpretation only up to his own prior knowledge and philosophical opinion. Rather than analyzing multiple points of view, Foucault examines only one side of a specific issue. One example of this is his description of the Hopital General as a “great confinement of the poor” (13). He fails to acknowledge the crimes that these inmates may have committed or the various circumstances behind their containment. When describing the spread of the institutions he cites a man named John Howard, again not providing any information as to his credibility, in stating that he was “outraged by the fact that the same walls could contain those condemned by common law, young men who disturbed their families' peace or who squandered their goods, people without profession, and the insane,” without analyzing the opposing view, perhaps from a guard or an overseer of the institution, in order to garner an unbiased, accurate viewpoint.

Foucault did, however, provide satisfactory organization throughout the book. By beginning with the end of the Middle Ages, Foucault offered a comprehensive view of madness throughout modern European history. Due to the fact that most of the public’s views were reflected by the arts, Foucault provided a glimpse into the public’s definition of madness through various works such as Brand’s “Ship of Fools,” Shakespeare’s “King Lear,” Georges de Scudery’s “Comedie des comediens,” a “theater of theater, situating his play, from

the start, in the interacting illusions of madness,” among other works, in the beginning of the book. This gave the reader an important idea of what is to come throughout the rest of the book. He also did a good job in organizing each chapter, providing a thorough analysis of every thesis that he chose to address. The chapters, covering everything from the method of confinement, to public opinion, to the types of madness, provide the reader with an overall sound, albeit biased, view of modern Europe’s definition of madness.

The utility of the book is damaged by Foucault’s bias and meritless evidence. The book provides an interesting glimpse into one side of Europe’s view of madness, and it certainly addresses the public’s view fairly well due to Foucault’s continuous referencing of works throughout the aforementioned historical periods. His evidence falls short in other areas, most specifically in his analysis of mental illness as he only mentioned one physician to back up his claim, and in the already mentioned analysis of the Hopital General. Due to the fact that the book has an apparent bias presenting the mad as victims rather than patients, as well as a lack of credible sources, the book should not be used for any works of scholarly merit. Instead, it should be considered a piece of philosophy with some historical context behind it.